一大群高加索慢性乙型肝炎患者口服治疗5年后的肝细胞癌预

StephenW

Hepatocellular carcinoma prediction beyond year 5 of oral therapy in a large cohort of Caucasian patients with chronic hepatitis B☆

    George V. Papatheodoridis
    Vana Sypsa
    George N. Dalekos
    Harry L.A. Janssen
    Thomas Berg
    Pietro Lampertico
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Published:January 22, 2020DOI:https://doi.org/10.1016/j.jhep.2020.01.007
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Highlights

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    Study conducted in Caucasians with chronic hepatitis B, with or without cirrhosis, after 5 years of entecavir/tenofovir.
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    Age >50 years, baseline cirrhosis and liver stiffness ≥12 kPa at year 5 were independently associated with increased risk of HCC.
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    CAGE-B score based on age at year 5 and baseline cirrhosis in relation to LSM at year 5 reliably predicted HCC risk >5 years.
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    SAGE-B score based only on age and LSM at year 5 was also a reliable predictor of HCC incidence >5 years.

Background & Aims
Hepatocellular carcinoma (HCC) may develop in patients with chronic hepatitis (CHB) even after 5 years of oral therapy and cannot be easily predicted. We assessed predictors of HCC development and the need for HCC surveillance in this setting.
Methods
Of 1,951 adult Caucasians with CHB included in the PAGE-B cohort, 1,427 (73%) had completed >5 years of follow-up under therapy without developing HCC by year 5. Median follow-up was 8.4 years from treatment onset. Points-based risk scores were developed to predict HCC risk after year 5.
Results
In years 5–12, HCC was diagnosed in 33/1,427 (2.3%) patients with cumulative incidences of 2.4%, 3.2% and 3.8% at 8, 10 and 12 years, respectively. Older age or age >50 years, baseline cirrhosis and liver stiffness (LSM) ≥12 kPa at year 5 were independently associated with increased HCC risk. The HCC incidence was lower in non-cirrhotics than cirrhotics at baseline with year-5 LSM <12; among cirrhotics at baseline, it was lower in those with year-5 LSM <12 than ≥12 kPa. CAGE-B score was based on age at year 5 and baseline cirrhosis in relation to LSM at year 5 and SAGE-B score was based only on age and LSM at year 5 (c-index = 0.809–0.814, 0.805–0.806 after bootstrap validation). Both scores offered 100% negative predictive values for HCC development in their low risk groups.
Conclusions
In Caucasians with CHB, the HCC risk after the first 5 years of antiviral therapy depends on age, baseline cirrhosis status and LSM at year 5. CAGE-B and particularly SAGE-B represent simple and reliable risk scores for HCC prediction and surveillance beyond year 5 of therapy.
Lay summary
In Caucasians with chronic hepatitis B, the risk of hepatocellular carcinoma after the first 5 years of entecavir or tenofovir therapy depends on age, baseline cirrhosis status and liver stiffness at year 5, which can provide simple and reliable risk scores for hepatocellular carcinoma prediction and surveillance beyond year 5. In patients with cirrhosis at baseline, liver stiffness <12 kPa at year 5 is associated with lower HCC risk, but surveillance may be still required.

StephenW

一大群高加索慢性乙型肝炎患者口服治疗5年后的肝细胞癌预测☆

    乔治五世·帕帕特奥多里迪斯
    瓦纳·西普萨（Vana Sypsa）
    乔治·N·达莱科斯
    哈里·詹森（Harry L.A. Janssen）
    托马斯·伯格
    Pietro Lampertico
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发布时间：2020年1月22日DOI：https：//doi.org/10.1016/j.jhep.2020.01.007
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强调

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    恩替卡韦/替诺福韦治疗5年后，对患有或不伴有肝硬化的慢性乙型肝炎的白种人进行了研究。
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    年龄> 50岁，基线肝硬化和第5年肝硬度≥12 kPa与HCC风险增加独立相关。
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    基于第5年的年龄和第5年与LSM相关的基线肝硬化的CAGE-B评分可靠地预测了> 5年的HCC风险。
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    仅基于年龄和5年LSM的SAGE-B评分也是> 5年HCC发生率的可靠预测指标。

背景与目标
即使经过5年的口服治疗，慢性肝炎（CHB）患者也可能会发展为肝细胞癌（HCC），无法轻易预测。我们评估了这种情况下HCC发生的预测因素以及HCC监测的必要性。
方法
在PAGE-B队列中有CHB的1,951名成年高加索白种人中，有1,427名（73％）在接受治疗后完成了5年以上的随访，到5年时未发生HCC，中位随访时间为从治疗开始的8.4年。开发基于积分的风险评分以预测5年后的HCC风险。
结果
在5-12年间，在33 / 1,427（2.3％）位患者中诊断出HCC，在8、10和12年时的累积发生率分别为2.4％，3.2％和3.8％。年龄大于或大于50岁，基线肝硬化和第5年肝硬化（LSM）≥12 kPa与HCC风险增加独立相关。 5年LSM <12时，非肝硬化患者的肝癌发生率低于基线时的肝硬化患者。在基线期的肝硬化患者中，5年LSM <12的患者低于≥12 kPa的患者。 CAGE-B评分基于第5年的年龄，基线肝硬化相对于LSM在第5年，而SAGE-B评分仅基于年龄和LSM在第5年（c-index = 0.809–0.814，0.805–0.806验证）。这两个分数在其低风险组中均提供了100％的HCC阴性预测值。
结论
在患有CHB的高加索人中，抗病毒治疗的前5年后的HCC风险取决于年龄，基线肝硬化状态和第5年的LSM。CAGE-B（尤其是SAGE-B）代表了HCC预测和监测后一年的简单而可靠的风险评分5疗法。
放置摘要
在患有慢性乙型肝炎的高加索人中，恩替卡韦或替诺福韦治疗的前5年后发生肝细胞癌的风险取决于年龄，基线肝硬化状态和第5年的肝硬度，这可以为肝细胞癌的预测和监测提供简单可靠的风险评分在第5年以后。在基线期肝硬化的患者中，第5年肝硬度<12 kPa与较低的HCC风险相关，但仍需要进行监测。